Skilled Nurse Rehab – Long Term Care Alternatives

In this episode, John Ross and Special Guest Alex Kent discuss what some of your options are as you try to recover from an injury needing more than just a few days of rehabilitation.

Episode Transcript
John
00:27 John: Welcome to Aging Insight everybody, this is your host John Ross here live in the studio today. It's windy, it's cold or it's cool-ish, it's cold for me, I'm from South Texas. Anything below about 80 is cold. But anyway, it's cold out there which means stay out of the wind. Get in your house, get in your car, turn on the radio and listen to Aging Insight where you might pick up a little something, you might learn something because we know that as elder law attorneys, as we're dealing with folks out there, we see that people have three basic concerns: They would like to avoid nursing home care if they can, and if they can't, they wanna get the best they can. They would like avoid becoming a burden on their friends and family and if they can't, if they're still going to depend on those family members, they wanna make that as easy on them as possible.
John
And the third thing is they would like to protect and preserve the resources that they've accumulated over a lifetime, so that they can provide themselves the best quality of life throughout that aging process. And we know that those things are possible, we also know that if you want to accomplish any of those goals, your job out there is to educate yourself on the myriad of rules and regulations and laws and all of these things that come piling on top of you as you navigate through this process. We can help, that's why we show up here every Saturday live, here available to take your call, if you have one you can always give us a shout. It's 903-793-1071, that's 903-793-1071, you can call about today's topic, you can call about any topic, see me as your stunt man, I look forward to the challenge, as usual.
John
Most people when I talk to them, I say "Well, what are you concerns?" And they'll say, "Just, I wanna stay independent, I wanna age at my home. Whatever it takes, whatever my care needs are, I wanna stay at home."
John
Okay. I hear that all the time and yet I was in a meeting this week and as part of this meeting, one of things we were going over were some of the statistics related to our particular community and one of those that struck me as a bit odd was that our area... And when I say our area, I'm talking about Texarkana and the surrounding communities, but our area has a disproportionately large number of people that leave inpatient rehab. Now inpatient rehab would be for example if you have a stroke, you go to ICU, after they stabilize you in ICU, you are admitted to an admitting room in the hospital where they keep an eye on you and try to figure out how you're doing, they run lots of tests and all of that.
John
And as they see that you are getting better, they think that maybe you might benefit from some rehabilitation but because you're still not very well, that still needs to be in more of a hospital like setting and so you have what they call inpatient rehab. That's typically in our area that's St. Michaels Rehab, there's also a Health South over downtown Texarkana. But you go in the inpatient rehab, and then you'll have a certain number of people that transition from there back home, and then you have another group of people that will transition from there into another form of rehab and this would be your skilled nursing rehab, where you're still getting some care, you're still in a facility but you're doing better, you could just still benefit from the rehab.
John
And despite the number of folks that have a tendency to say, "Well, yeah, I wanna try to get all my care in the home as much as possible," in our area we have a disproportionately large number of people that are transitioning from that inpatient rehab into the skilled nursing rehab, and we're higher than the national averages on these things. We don't have an explanation necessarily for why, I have a few things that I suspect. For example, a lot of times even though the person is no longer medically fit for inpatient rehab that doesn't mean they still don't need some care, and in fact they may not be able to care for themselves without assistance. Those people may then want to go home but they can't because they need that additional assistance.
John
We have, for example, under the Medicaid program, there is a in-home care benefit program. It's what's called a Medicaid waiver program. On the Arkansas side they call it Elder Choices. On the Texas side they call it the Star Plus waiver. Because most people, or at least most people I deal with, could not afford to pay somebody $15 to $20 an hour for somebody to sit there in the house with them to help them get off the couch, to the bathroom, and back to the couch all day long at that rate. If you're talking 24 hours a day at $15 an hour, you're looking at 300 bucks a day, give or take. That's $9,000 a month depending on how often you're using it and all of these sort of things. It can be very expensive, so most people cannot afford to just private pay for that care and in which case they have a tendency to opt for, trying to look at something like a Medicaid program.
John
The problem is, at least on the Texas side, the Star Plus waiver program is poorly funded, and because of that there is often a waiting list, which in some cases can be 12 months, 16 months, 18 months, two years depending on your location. If you are a person who wants to transition out of the inpatient rehab at the hospital to a home environment where you're going to need care but you cannot afford that care, even if you meet the eligibility requirements under Medicaid, you still can't get the care, all you are is sitting there on a waiting list and that doesn't do you any good. Considering that most of the... Our population is obviously split between the two state lines here in town, but a much larger percentage of them are coming from the Texas side. Those Texas side folks just do not have the access to the in-home care assistance, at least under the Medicaid program.
John
You've probably heard me talk about the veteran's benefit program on the show before, that can bring in some extra cash to help pay for the in-home care assistance. But even a claim for veteran's benefits, if the VA is surprising fast at processing your claim, you can still expect to be spending about two to three months waiting for that claim to finally turn into an actual deposit in your bank account and you don't have that two to three... You need the care starting with day one. I have a feeling, and I don't have anything to back this up, but I just have a feeling that there are a disproportionate number of people that, because they don't have access to either an immediate veteran benefit or an immediate Medicaid benefit, and yet still need some care, they essentially, at least for our Texas patients, have no choice but to transition from the skilled nursing... From the inpatient rehab to the skilled nursing rehab, hoping that that additional say 20 to 100 days of care that they can get in that facility will actually allow them to get to a point where they can go back home without the care.
John
Where your neighbor who left the rehab hospital and went home is gonna spend 18 months sitting on a waiting list, waiting for in-home care assistance; the other person that went to the skilled nursing facility, qualified for Medicaid, gets put on the top of the waiting list, and 30 days later, is back home with Medicaid assistance. That's obviously a huge difference between the two, and it could be that that's a reason for the disproportionately large number of folks, that are going from rehab, hospital to skilled nursing, in our community. I don't know that for sure, but it seems like that's a... That makes sense to me. Now, of course, that assumes that people are knowledgeable about such things, which, if everybody knew all about this stuff, I would be out of business and wouldn't have anything to talk about here on the radio show.
John
So, maybe I can just assume that all of those people that are opting to go that route, they just happen to be Aging Insight listeners, and they've learned all of this stuff from listening to Lisa and I come on here and run our mouths. But, with all that being said, there's still a lot of confusion, because they're changing these rules all the time. Most of this stuff is at least initially paid for by Medicare, so whether you’re in that inpatient rehab at the hospital, or whether you're in that skilled nursing facility, at least for that first 20 to 100 days, those are all Medicare coverages.
John
And as they tinker with the payment sources and all of this, it may very well come down to a point where you're... You'll have a choice to maybe bypass the inpatient rehab altogether and go straight to the skilled nursing facility rehab, based on your health, but also in part, because based on what Medicare's going to be paying for. So, there's probably gonna be some changes along with all of this. All of that brings up the point that we gotta know more about how you pick these sort of things, what you look for, what the regulations are, and that sort of stuff. Which is some of the stuff that we're gonna be talking about today. So, I'm gonna take a quick little break, and as we come back, we're gonna delve into this, maybe bring in an expert on the subject. So, stick around, we'll be right back.
John
Welcome back to Aging Insight everybody, this is your host John Ross, live in the studio. If you've got a question, feel free to give us a call. Phone number is 903-793-1071, and today we're gonna be talking about... I started out by talking about that there's kind of a higher number of people in our community as opposed to the national average, that transition from inpatient rehab, like at a hospital, like at St. Michael's Rehab facility to skilled nursing facility like for example, Reunion Plaza or their Twin City Rehab facility. That's a skilled nursing rehab facility. And so, across the nation, fewer people go directly home after that hospital stay, whereas in Texarkana, more people are opting to continue that rehab in the skilled nursing environment.
John
And if you're that person and you're trying to figure this out, there's a lot to try to figure out as to whether or not that's the appropriate choice for you. So, with all that being said, I brought onto the show today, I've got Alex Kent who is the clinical director for Reunion Plaza and Twin City Rehab out there. Alex, welcome.
Guest
Thank you. Thank you for having me, John.
John
So, let's see, you're the clinical liaison which does what?
Guest
I am the connection between the facility and the hospital, so I'm actually the first point of contact for the potential patients. I will go and do a medical assessment in the hospital. I will answer any questions they have regarding insurance, the care at the facility, and I make sure there's a smooth transition from hospital to facility, make sure we have everything we need to take care of them when they come in the building.
John
And you're an RN. Been RN for six, seven years -ish?
Guest
Yes, yes, ish.
John
Ish, yeah. Okay. So, they call both of these the inpatient rehab and the skilled nursing rehab, they call it all rehab.
Guest
Right, confusing.
John
Yeah. If you're the average consumer, that could be difficult to determine. It's not quite the same, it's a different environment.
Guest
It is. It is a different environment.
John
And typically, at least from my understanding, in the hospital environment, there's more actual medical type care. If somebody is for example recovering from, I don't know, a brain injury as a result of a motorcycle wreck. I have a client that had a motorcycle wreck this last week and has a traumatic brain injury. But along with the traumatic brain injury, there's broken bones, there's scrapes, there's open wounds, there's lots of... The clinical term would be comorbidities. So, that's the kind of thing that you see in an inpatient typically, right?
Guest
Correct. Anybody that's more acute, meaning more ill, needing more monitoring, more care, more resources at their fingertips, they would be in an inpatient rehab.
John
Then if there's some of those other illnesses are kind of under control, not necessarily fixed, but they're at least under control, but they can still benefit from the rehabilitation services.
Guest
Correct. And we do... We are able to provide a lot of services such as lab draws, X-rays if need be. But the monitoring such as telemetry and things like that, we can't provide.
John
I don't even know what that is.
Guest
Heart monitoring.
John
Gotcha, okay.
Guest
And, we can't provide those things. So, yes, we do offer the same therapies as the rehab facility, physical therapy, occupational and speech therapies, but we are not licensed to give as many hours as they are. So, their therapies are a little more intense in time.
John
And so, we're talking about the difference between, say, three to four hours in an inpatient.
Guest
Yes. And, we're licensed anywhere from two to two-and-a-half hours per day.
John
That's per day. And then what, like, five days a week, six days a week, something like that?
Guest
Six.
John
Six days a week. But that's still done. That therapy is done in the facility, you're not leaving the facility to go to some other place?
Guest
No, sir. All your care is provided in the facility everywhere from your therapies, lab draws, we provide medications. We do have wound care nurses on staff, so if you do have a wound that is being monitored and treated by a professional there.
John
So yeah, so I guess then it's... If you're that family... Now, do you see people... I guess, some people then if they've had stroke for example, they're still in the hospital itself. If they don't have these other illnesses and stuff, those folks may be able to bypass the inpatient rehab and go straight to a skilled facility, is that right?
Guest
Yes, that is correct.
John
But I guess, it'd be hard for them to determine that. If you're the patient, that's pretty hard to determine.
Guest
Yes, it is. I understand it's a difficult choice and you have a lot of options here in Texarkana.
John
I think the other thing is you've gotta... All of this stuff has a tendency to be a business. So, if you're at one facility that offers inpatient rehab as part of their services, they might have a tendency to think that that's more appropriate for you. I know most of them... I know St. Michaels tries to screen pretty well, but I know other facilities that don't try to screen near as well and have a tendency to refer to that internal situation. So yeah, it's difficult. And if you do or if you are looking at this, then you've got a lot of issues to try to figure out. And so, when we come back from the break, we're gonna talk about that. Stick around.
John
Welcome back everybody, this is John Ross here for the second half of the program on Aging Insight. Feel free to give us a shout if you have any questions, the phone number is 903-793-1071 and I'm in the studio today with Alex Kent. She's the clinical liaison person for Reunion Plaza and their Twin City Rehab. And we keep saying Reunion Plaza and their Twin City Rehab, I guess they're two entities out there, but it's all part of the same building.
Guest
Yes. It's Twin City Rehab at Reunion Plaza, it is a separate rehab wing, separate from our long-term care division.
John
And it seems like I went to the grand opening which was November-ish?
Guest
Yeah, it was in November.
John
Okay, that's what I was thinking. Yeah, brand new. So, it's brand new. And one of the things that, for example, in the acute care rehab, the hospital rehab environment, we have I guess basically two options in town, that will be St. Michaels Rehab and Health South Rehab. Is that basically right?
Guest
Mm-hmm.
John
Yeah. Both of them have been around for a long time, both of them do their thing. I have a tendency to be a little partial to one over the other, but that's neither here nor there. But both of these at least as far as the facilities themselves have some similarities. For example, the individual patient rooms, all two person rooms.
Guest
Correct, yes.
John
Whereas in your facility, it's all single person rooms.
Guest
Yes. The new rehab wing that we built on, it has 19 private rooms, fully private. Then we have eight that are what we call semi private, two patients are able to go into those rooms. But actually we use those rooms more for family members. A lot of times we see elderly people who go into our facility whose kids all live out of town. Well, when they come in, they have no where to stay. So we do have that option. And we also have an adjacent unit that's our overflow unit that has 15 private rooms as well.
John
Okay, so what's that? 21 total, something like that?
Guest
Yes.
John
I've ran out of fingers.
Guest
35. It's closer to 35, yeah.
John
And one of the things... From the one standpoint there's a medical aspect to this. You need to make sure that you're getting the right treatment in the right place. I know nothing about medical care. I'm a pretty smart guy, I've been around this sort of thing for a while. But yet I end up ultimately having to rely on the people who are telling me what to do. Which my experience with my clients in this environments is that they get a lot of conflicting information in all of this. How do they know who to talk to? Who do they listen to? For example, if they've called you and you've said, "Yeah, we're appropriate, you're appropriate for our facility." And they've talked to the social worker at the facility who says, "Well, you could also benefit from our acute care rehab." It seems like that would be difficult.
Guest
It is. It's a difficult situation. One thing that we try to do after somebody's been in the hospital sometimes for weeks, they're just ready to go home. Being in a clinical type setting, it's hard. If you are appropriate for ours, we are set up more as not so clinical. We're more homey, more I guess comfortable is the word to say.
John
Sure. And again y'all's, the facility is certainly very nice and it's much more... Because you've had the opportunity to build from the ground up. And it does, it looks a bit homier. You'll see some of the other... In the long term care scenarios a lot of the facilities have been around for a long time. The newer ones you see, everybody's moving towards this more home like environment. Even in our own office if you go in our main conference room, yeah, we call it a conference room, there's a big living room, it's a big dining room table, and a buffet table, and Lisa Shoalmire's great-grandmother's cross stitch hanging on the wall. And again it's to create that home environment. We want people to be comfortable. Because frankly if they're dealing with the legal side of the long term care, it's complicated, it's hard to understand, you're nervous, you're freaking out. We need to bring that comfort level down, which increases the clients' understanding. So I would think from a clinical standpoint, the more comfortable you are, the more receptive you're going to be to the medical treatment.
Guest
Absolutely. That's where we were going with that. The more comfortable they are, the better they're gonna do with their therapy, the better they're gonna accept the treatments.
John
And of course that's for most people, even people that are on Medicare they don't necessarily realize that that's typically a Medicare covered service.
Guest
Absolutely. Medicare will cover at 100% for the first 20 days. On that 21st day you run into a co-pay, but a lot of our patients have the supplemental insurance that typically will pick it up.
John
And of course that's something that we've talked about on the show before, and I've gotta get Jay Barnett on here at some point in time to talk about it. And this is off topic a little bit, but as you get older and you're increasing your likelihood of needing these kind of long term care services, get out of your Medicare advantage plan. Would you agree?
Guest
I don't know if I'm allowed to comment on that.
John
I can. I've talked to lots and lots of people who are more than happy to tell me that traditional Medicare with a supplement, you often are gonna get an increased... You're gonna get that other 80 days beyond the initial 20. Whereas your advantage plans oftentimes really will start cutting right at around the 20 to 30 day mark. You're just not gonna get the level of rehab typically with those others... Anyway, that's off topic.
Guest
Well, I can say this. I will say the managed Medicares that a lot of people are going to, they dictate the care essentially. If I have a Medicare patient coming in from the hospital, I don't have to get approval. If we feel that there is a need there and they're able to participate, we can go ahead and bring them in, of course if they have their three midnights. With managed care, they review the case, and they decide if this person needs therapy. So it's always something to keep in mind.
John
Right. When I'm talking to my teenagers, I do the paying, so I do the saying. And oftentimes with these managed care facilities, that's how they look at it is, "We're doing the paying, so we decide the medical treatment." As opposed to the medical providers, providing the treatment, or making those decisions, and then getting it paid for through your traditional Medicare-type plans. But anyway, that's off topic but I did have another off topic on the same thing. Which is, I understand that one thing the patients themselves need to look out for, because it's not being done well by the professionals in charge, doctors, is your prescription drugs that you're on and making sure those flow with you out of the hospital facility and to the rehab so that what you were taking in the hospital is the same that you're taking out of the hospital. I've understood that there's been some problems in all of that.
Guest
Yes, that has happened and we get... When somebody comes from the inpatient rehab to our facility, we get the discharge orders that the physician wrote. So unless the patient is coming to us, telling us that, "No, we were on this or that or the family," we wouldn't know, because every record we get is from their inpatient stay.
John
Right, which maybe different than something else out there. And even within the hospitals themselves, as somebody goes from the intensive unit to the regular admission wards to the inpatient, this is a problem that they're having throughout the medical community is, they've identified the medical care but they're having a hard time following the drugs along with that, which can cause some complications. So, it becomes very important to you people out there, as you're trying to figure out some of these things. For example in our practice, when we do powers of attorney for people, we store those electronically. And the company that we use to provide the electronic access to your powers of attorney, will also provide electronic storage of your medical, your prescription drug information.
John
So that when you go from, to the hospital and they say, "Do you have a medical power of attorney?" You can whip out your card. And not only does the hospital get a copy of the medical power of attorney, they also get a copy of your prescription list. And then when you go from there to the next thing, same thing. And so, if you can keep that updated along with your other documents, that can help with all of that. Now, that's neither here nor there. Because the last part of all of this that I wanted to talk about is, ultimately, there is a lot of competition in the long term care. Regardless of whether you're going directly from the hospital or whether you're going from the inpatient rehab, regardless if you're going to one of these facilities, there's a lot of competition in that market.
John
Even in a small community, it's not uncommon. When I say small community, I'm talking about something like Atlanta, Texas. You still got more than one option. And so, when you get into a small community like Texarkana, you may have several options. You get into a big market like Dallas, or something like that, and you're gonna have hundreds of options. And so, how do you identify that? We're gonna talk a little bit about that in our last segment, so stick around. We'll be right back.
John
Welcome back everybody. This is our last segment, so if you got any questions you better get them in. The phone number is 903-793-1071. This is John Ross. I'm in the studio with Alex Kent, the clinical liaison person with Reunion Plaza and Twin City Rehab. And we've been talking about lots of different things. But anytime you start talking about long term care facilities, and I have this conversation all the time. We have the Aging Insight Resource Guide. It's our magazine that we put out. You can find it all over the place. In doctor's offices and in the Rehab Hospitals and things like that. The reason I put that out and the reason I give them away and make sure they're accessible out there, is because in the back I have a list of all of the various senior services.
John
But it's not uncommon, I've got somebody sitting in my office and they're holding that magazine and they're saying, "Okay, John, yeah this is great, now I have a list but so what? How do I pick between the seven or eight that are on here?" And a lot of times, I say a lot of times. Sometimes, especially if I'm dealing with the kids, the kids are pretty internet savvy. And when I say kids often times I'm talking about people my parents age, 'cause they're dealing with their parents. But the kids they're a little more internet savvy and they've gotten on. I'll say, "Well, you ought to check out this Twin City Rehab, it's a new facility, they've got individual rooms as opposed to the two person rooms that's gonna be a hot spot for a lot of people, they're gonna really like that."
John
And they'll say, "Well, I was looking on the CMS website and there's the nursing home rankings, and here's one and it's ranked higher than theirs." Yeah, you know what? That's right, there is a ranking system out there. There's a whole laundry list of things that these centers from Medicare and Medicaid services, CMS rates these places on like the number of residents that have severe pain, or the number of residents with pressure ulcers and things like that. Then of course, falls, other long term things, urinary tract infections, a bunch of that sort of stuff.
John
And just here in the last week or two, CMS has announced that they're gonna add even more various, "Quality measures." To all of this stuff. The fact is though, the ranking system is about as reliable... Well, I can't even think of it. It's about as reliable as tap water in Nuevo Laredo. Not necessarily something you wanna put all of your faith in. One of the things I wanted to bring up was these rating systems. Essentially, the rating systems are based on a very brief window on the facility. They basically come in, don't they? They come in and look at you for about a week or two or something like that?
Guest
Usually just a week.
John
And so everything that they're basing the stuff on is based on that one week. Not necessarily what happened the week before or even the year before. And so, for example, let's say you have, let's say there's just a rush of people that are transitioning from the hospital to your facility. Those people developed pressure ulcers in the hospital but y'all have wound care people, so you can accept these people even though they have a pressure ulcer. You didn't cause it, you didn't do anything else. But if they're at your facility and have a pressure ulcer you're gonna get dinged
Guest
Correct.
John
You know?
Guest
It does help though that they did develop that pressure ulcer at the hospital.
John
Right.
Guest
That does help us a lot. But then we also get into the situation of non-compliance, which in the medical world we see that all the time. That's no different when somebody comes into our facility. So we can't make Mr. So-and-so turn every two hours if he keeps getting back on the side. There's a lot of challenges there, that don't really depict the full picture.
John
Yeah, I was reading an article from the caring.com website and it was talking about how, essentially how poorly these reports actually reflect anything. And it was talking about, for example, the staffing issue. Staffing I guess is a big thing that the number of nurses and CNAs and things like that per patient, I suppose there's some sort of ratio or something that you're supposed to maintain. But if they don't look at it across, say a six month period or a year period, they're basically looking at it that day or that week that they're there. So for example, if they come in during the ice storm...
Guest
Exactly.
John
Or last week, or this week where we've just had bad weather and people are flooded, and...
Guest
Stomach virus at the facility. All sorts of things could affect that.
John
Yeah. And you end up getting... Say, in this article. It was talking about these reports which become public information, are wildly inaccurate at describing the staffing levels, and some of that stuff. You honestly really, although CMS has certainly, they put a lot of effort into putting out these star rating programs and making them available on the internet and all of that. The fact is, they're just not reliable. So, you've got to come up with another way of determining which of these facilities you wanna go to if you're headed that direction. And I've really wouldn't give much of this stuff much credit. Especially in a town like Texarkana, because one of the things it was noting on here is that the rating system and how they're rated vary from state-to-state.
Guest
Correct. Our criteria's completely different than Arkansas.
John
So, two identical facilities with identical situations and identical staffing numbers and all of these things, if everything else were the same, just by virtue of being on one side of the state line or the other, one ends up with a higher star rating than the other. And in a town like Texarkana, it just doesn't make any sense. Because you cannot compare, if you type in Texarkana, Texas in the CMS website, you get Texarkana, Texas and Texarkana, Arkansas. And Little River County, Arkansas and Cass County, Texas. And here's all of these. And if you're comparing them side by side, the consumer never understands the fact that you're comparing apples to oranges.
Guest
Correct. And there's a lot that goes into that overall star rating. I would definitely encourage everybody that is looking that up. Even though these quality measures aren't exactly reliable, because it is done in a one week period. That overall star rating might be a lot lower because of one incident. So, that really had nothing to do with patient care.
John
Yeah. And if you're that involved in it, ask.
Guest
Yes. Yes. I would be happy to explain it.
John
Yeah. Before you go writing somebody off, there's lots of facilities in town. Some of them are better than others. There's no question about it. But that is not necessarily the measuring factor. A lot of times it's almost more of a personal factor where all of the people that work in this industry are looking out for people's care. Yeah, they're businesses. Yeah, they're not in this for pure charity purposes. But ultimately I think everybody's hearts are in the right places. And that's generally across the board. Then after that, if everybody is trying, then you've gotta look down to what fits with your family, your personality, things like that.
Guest
Yes. And that's why I encourage everybody to come look at your facilities. Physically go and take a tour. You can tell a lot just by walking in the doors about the atmosphere of that facility and how your loved one would fit there.
John
Which is why I went over and looked at yall's place.
Guest
I'm glad you did.
John
Which I'll open. Because people ask me all the time, do I have an opinion about these things. And I will say that generally, I have a relatively neutral opinion on many facilities. There are a few that I have a negative opinion on. Well, I usually don't make recommendations for one over the other between two that I think are mutual. I do try to find a fit for the person that I think would be appropriate. And I'm not opposed to telling people, "No, that place, you don't wanna go there." I'm a trusted independent third party. And if I'm gonna be making that kind of recommendation, I need to go in and put eyeballs on the place. And if you're talking about moving a family member in there, do the same.
Guest
Absolutely. Absolutely. Go and see where you're putting them, and make sure you feel comfortable.
John
Yeah. And compare. Especially when you're talking about the difference between the long term care rehab environment versus the acute care, make sure you understand the difference you're gonna get. Because it may be more appropriate to be in a place like Twin City rehab as opposed to an inpatient rehab. Or transitioning from one to the other. Anyway. Lots of good information. Appreciate everybody listening. Once again, let me thank my sponsors. Texarkana Funeral Home. Advantage Senior Care. Edgewood Manor. The Barnett Agency. Dierksen Memorial Hospice. Cranfill & Associates. Riverview Behavioral Health. Cowhorn Creek Estates. Curt Green & Company. Guaranty Bank and Trust. St. Michael's Hospital. The Retreat At Kenwood. Heritage Plaza. Red River Federal Credit Union. Carter Insurance. And Reunion Plaza. And, thank Alex for coming on the show.
Guest
Thank you for having me.
John
We'll see you next time everybody.

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